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The emergence of antimicrobial resistance as a public matter of concern: A Swedish history of a “transformative event”
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology. (Cultural Matters Group, Welfare and Life Course Research Group)ORCID iD: 0000-0001-9959-3245
2018 (English)In: Science in Context, ISSN 0269-8897, E-ISSN 1474-0664, Vol. 31, no 4, p. 477-500Article in journal (Refereed) Published
Abstract [en]

This article examines how antimicrobial resistance (AMR) came to be constituted as a matter of public concern in Sweden in conjunction with the development of an inter-professional organization called Strama, founded to promote rational prescription of antibiotics. An outbreak of penicillin-resistant pneumococci in the mid-1990s was crucial for this development, because it brought attention to AMR as an urgent public threat. This outbreak fuelled the constitution of AMR as caused by consumption of antibiotics and as a matter of disease control. As a consequence, Strama was able to mobilize the Swedish health officers responsible for disease control. The outbreak is conceptualized as a “transformative event” – an event that makes an issue and its associated risks concrete and urgent. Transformative events play the crucial role of expediting the transformation of issues into matters of public concern.

Place, publisher, year, edition, pages
2018. Vol. 31, no 4, p. 477-500
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-358019DOI: 10.1017/S0269889718000315ISI: 000455458000004PubMedID: 30630548OAI: oai:DiVA.org:uu-358019DiVA, id: diva2:1241354
Available from: 2018-08-23 Created: 2018-08-23 Last updated: 2019-02-01Bibliographically approved
In thesis
1. Unpacking Rational Use of Antibiotics: Policy in Medical Practice and the Medical Debate
Open this publication in new window or tab >>Unpacking Rational Use of Antibiotics: Policy in Medical Practice and the Medical Debate
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rational use of antibiotics–using antibiotics only when needed and in the right way–is a prioritized goal in policy aimed at preventing antimicrobial resistance. A vast body of research is devoted to understanding why unnecessary antibiotics are prescribed. However, this research tends to treat the definition of rational prescribing as an unproblematic fact, which is given by evidence.

The thesis aims to sociologically unpack rational use of antibiotics as medical knowledge and a policy goal. One study examines how rational use of antibiotics in health care was established as a crucial part of AMR prevention in Sweden, and three studies, drawing on different materials, look at how rational antibiotic use for everyday infections is negotiated and performed in medical practice and the medical debate in Sweden. The thesis makes theoretic use of material semiotics and critical policy studies, which enables examination of how medical knowledge, medical objects and policy are performed in webs of relations between human and non-human actors.

The studies show that rational use of antibiotics for everyday infections is characterized by uncertainties and tensions. These cannot be reduced to medical professionals’ ignorance, or to how non-medical factors influence medical practice. This implies that social factors are not enough to explain why medical professionals dismiss specific policy definitions of medically appropriate prescribing. Instead, the uncertainties and tensions characterizing rational antibiotic prescribing can be traced to the complex and contingent nature of medical knowledge and medical objects, as well as to the potentially conflicting risks that antibiotic prescribing involves. As a consequence, deviance from, or critique of, a specific definition of rational use of antibiotics may constitute a performance of rational use of antibiotics as a policy goal. In medical practice and the medical debate, rational use of antibiotics as a policy goal can draw on and work with mutable medical knowledge and objects, as well as conflicting medical risks. It is concluded that sociologists need to continue entering the seemingly pure medical sphere to critically investigate policy and policy goals that draw on medical knowledge and that, as such, appear to be neutral and undisputable.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 72
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 158
Keywords
Antibiotics, Policy, Medical Sociology, Actor-Network Theory, Human-microbial relations, Antimicrobial Resistance, Everyday Infections, Material semiotics, Medical sociology, Medical objects, Medical technologies, Medical knowledge
National Category
Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:uu:diva-358022 (URN)978-91-513-0421-2 (ISBN)
Public defence
2018-10-12, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-20 Created: 2018-08-23 Last updated: 2018-10-02

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